Risk factors and clinical outcomes of extrahepatic recurrence in patients with post‐hepatectomy recurrent hepatocellular carcinoma

Background Extrahepatic recurrence remains a major obstacle to an improved prognosis in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. Methods From January 2001 to December 2014, we screened 1330 consecutive patients who underwent curative hepatectomy for HCC. Patients who experienced recurrence were enrolled in this study and divided into an extrahepatic recurrence (EHR) group and a pure intrahepatic recurrence (IHR) group. Clinical data and follow‐up results were retrospectively collected and analysed. Results A total of 556 patients were enrolled (EHR, 52; IHR, 504). In the EHR group, the lung was the most common site of extrahepatic recurrence (53.8%), among which 67.3% had associated intrahepatic lesions. Background Hepatitis B (HR 0.282; 95% CI 0.106–0.752; P = 0.011), tumour size ≥10 cm at initial diagnosis (HR 2.679; 95% CI 1.283–5.596; P = 0.009) and blood transfusion during initial surgery (HR 2.218; 95% CI 1.132–4.346; P = 0.020) were predictive of EHR. A multidisciplinary team treated recurrent HCC. After a median follow‐up period of 46 months (range, 24–192 months), the 1‐, 3‐ and 5‐year overall survival rates in the EHR group were 60.7%, 8.9% and 0%, respectively, after recurrence, and 78.8%, 30.2% and 8.9%, respectively, after initial surgery, which were much lower than those in the IHR group. Conclusion Tumour size ≥10 cm and blood transfusion during initial surgery were predictive of extrahepatic recurrence in patients with post‐hepatectomy recurrent HCC. Treatment options were limited, and long‐term survival was unsatisfactory. A total of 556 consecutive patients who developed recurrence of HCC after curative liver resection were enrolled in the study to investigate the risk factors of extrahepatic recurrence. The results showed that tumor size = 10 cm and blood transfusion were predictive for extrahepatic recurrence after curative liver resection, while the long‐term survival of these patients was depressing.